Basic Information
| Provider Information | |||||||||
| NPI: | 1225058308 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SONCASIE | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | R. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 W NIFONG BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652034469 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734999009 | ||||||||
| FaxNumber: | 5734994400 | ||||||||
| Practice Location | |||||||||
| Address1: | 900 W NIFONG BLVD STE 101 | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 65203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734999009 | ||||||||
| FaxNumber: | 5734994400 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 08/06/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 111504 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 111504 | MO | N | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 208504514 | 05 | MO | MEDICAID | P00349316 | 01 | MO | RR MEDICARE | OTHER |